BLK Super Speciality - MyHealthcare

MyHealthcare Platform Services Agreement

Date:

Company Name*

Company Address*

Hospital/Clinic Name*

GST Number*

PAN*

CIN Details*

Registered Address*

City*

State*

Pin Code*

Country*

NO OF UNITS TO BE ONBOARDED

Unit Name*

Helpdesk Contact Number*

Helpdesk Email*

BANK DETAILS

Account Holder Name

Bank Name

Bank Account Number

Bank Address

MICR Code

IFSC Code

FEES: MyHealthcare Technologies Private Limited shall charge the Company the following fees to offer a solution for immediate deployment:

Summary	Charges
One Time Fee	Waived
SaaS Charges per video consultation (inclusive of video license platform, cloud hosting services and storage on AWS India)	INR 200 (inclusive of GST)
SaaS Charges per OPD consultation	INR 40 + GST
Platform support	Included in above SaaS Charges
Platform customisation and Change Requests	INR 2,200 per person- per Work Hour

*MyHealthcare Technologies Private Limited to raise invoices in this respect, on a Weekly Basis

This MyHealthcare Services Agreement (“Agreement”) contains the Terms of Use on which the Company agrees to use the MyHealthcare Platform for providing healthcare consultation services to patients in India and abroad, and the terms and conditions on which MyHealthcare agrees to allow the Company to use the MyHealthcare Platform and provide the Services to the Company.

AUTHORISED SIGNATORY

Name*

Designation*

Mobile*

Email*

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